Provider Demographics
NPI:1871758201
Name:DEHART, G. KENNETH JR (MD)
Entity type:Individual
Prefix:
First Name:G. KENNETH
Middle Name:
Last Name:DEHART
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1298 SAVAGE POINT ROAD
Mailing Address - Street 2:BOX 126
Mailing Address - City:NORTH HERO
Mailing Address - State:VT
Mailing Address - Zip Code:05474-0126
Mailing Address - Country:US
Mailing Address - Phone:802-372-6739
Mailing Address - Fax:
Practice Address - Street 1:1298 SAVAGE POINT RD.
Practice Address - Street 2:BOX 126
Practice Address - City:NORTH HERO
Practice Address - State:VT
Practice Address - Zip Code:05474-0126
Practice Address - Country:US
Practice Address - Phone:802-372-6739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-00031472085D0003X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Neuroimaging
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology